Healthcare Provider Details

I. General information

NPI: 1154257988
Provider Name (Legal Business Name): MAURICIO JAVIER PEREYRA GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 HOLMBERG RD APT 1021
PARKLAND FL
33067-4519
US

IV. Provider business mailing address

5851 HOLMBERG RD APT 1021
PARKLAND FL
33067-4519
US

V. Phone/Fax

Practice location:
  • Phone: 786-585-0105
  • Fax:
Mailing address:
  • Phone: 786-585-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: